Skip to main content
SpringerLink
Log in

Thyroid Incidentalomas

  • Chapter
  • First Online:
Thyroid Nodules

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Thyroid incidentalomas are nonpalpable, asymptomatic thyroid nodules that are discovered on an imaging study performed to evaluate other structures or during an operation unrelated to the thyroid gland. Thyroid incidentalomas are most commonly detected on ultrasound (US) performed for evaluation of extra-thyroidal structures, followed in frequency by computed tomography (CT), magnetic resonance imaging (MRI), and 18fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography [PET] (18FDG-PET). Clinically unrecognized thyroid nodules are common and can be found in up to 50–60% of patients at autopsy. Increased use of imaging modalities of better quality in the modern era has resulted in an increased detection of incidental thyroid nodules. Their clinical importance is primarily related to the need to exclude thyroid cancer. The risk of malignancy in these nonpalpable nodules is similar to that of palpable nodules. As result, a thorough sonographic evaluation of the thyroid gland should be performed in the majority of patients with a thyroid incidentaloma. If a thyroid nodule is confirmed, then it should be evaluated in the same fashion as a clinical apparent thyroid nodule. As with most thyroid nodules, the majority will prove to be benign. However, as more studies come into light, we come to realize that the majority of incidental thyroid nodules that harbor cancerous cells are small indolent papillary carcinomas that do not result in increased mortality, and in such cases, a less aggressive and cost-effective approach is advised.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Black WC, Welch HG. Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy. N Engl J Med. 1993;328(17):1237–43.

    Article  CAS  PubMed  Google Scholar 

  2. Bailey RH, Aron DC. The diagnostic dilemma of incidentalomas. Working through uncertainty. Endocrinol Metab Clin N Am. 2000;29(1):91–105.

    Article  CAS  Google Scholar 

  3. Vassiliadi DA, Tsagarakis S. Endocrine incidentalomas—challenges imposed by incidentally discovered lesions. Nat Rev Endocrinol. 2011;7(11):668–80.

    Article  CAS  PubMed  Google Scholar 

  4. Furmanchuk AW, Roussak N, Ruchti C. Occult thyroid carcinomas in the region of Minsk, Belarus. An autopsy study of 215 patients. Histopathology. 1993;23(4):319–25.

    Article  CAS  PubMed  Google Scholar 

  5. Turner HE, Moore NR, Byrne JV, Wass JAH. Pituitary, adrenal and thyroid incidentalomas. Endocr Relat Cancer. 1998;5:131–50.

    Article  Google Scholar 

  6. Mevawalla N, McMullen T, Sidhu S, Sywak M, Robinson B, Delbridge L. Presentation of clinically solitary thyroid nodules in surgical patients. Thyroid. 2011;21(1):55–9.

    Article  PubMed  Google Scholar 

  7. Hegedus L. Clinical practice. The thyroid nodule. N Engl J Med. 2004;351(17):1764–71.

    Article  PubMed  Google Scholar 

  8. Hagag P, Strauss S, Weiss M. Role of ultrasound-guided fine-needle aspiration biopsy in evaluation of nonpalpable thyroid nodules. Thyroid. 1998;8(11):989–95.

    Article  CAS  PubMed  Google Scholar 

  9. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Katz SC, Shaha A. PET-associated incidental neoplasms of the thyroid. J Am Coll Surg. 2008;207(2):259–64.

    Article  PubMed  Google Scholar 

  11. Rothman IN, Middleton L, Stack BC Jr, Bartel T, Riggs AT, Bodenner DL. Incidence of diffuse FDG uptake in the thyroid of patients with hypothyroidism. Eur Arch Otorhinolaryngol. 2011;268(10):1501–4.

    Article  PubMed  Google Scholar 

  12. Wiltshire JJ, Drake TM, Uttley L, Balasubramanian SP. Systematic review of trends in the incidence rates of thyroid cancer. Thyroid. 2016;26:1541–52.

    Article  PubMed  Google Scholar 

  13. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295(18):2164–7.

    Article  CAS  PubMed  Google Scholar 

  14. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014;140(4):317–22.

    Article  PubMed  Google Scholar 

  15. Hoang JK, Langer JE, Middleton WD, Wu CC, Hammers LW, Cronan JJ, et al. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol. 2015;12(2):143–50.

    Article  PubMed  Google Scholar 

  16. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22(6):901–11.

    Article  PubMed  Google Scholar 

  17. Gharib H. Changing concepts in the diagnosis and management of thyroid nodules. Endocrinol Metab Clin N Am. 1997;26(4):777–800.

    Article  CAS  Google Scholar 

  18. Tomimori E, Pedrinola F, Cavaliere H, Knobel M, Medeiros-Neto G. Prevalence of incidental thyroid disease in a relatively low iodine intake area. Thyroid. 1995;5(4):273–6.

    Article  CAS  PubMed  Google Scholar 

  19. Imaizumi M, Usa T, Tominaga T, Neriishi K, Akahoshi M, Nakashima E, et al. Radiation dose-response relationships for thyroid nodules and autoimmune thyroid diseases in Hiroshima and Nagasaki atomic bomb survivors 55–58 years after radiation exposure. JAMA. 2006;295(9):1011–22.

    Article  CAS  PubMed  Google Scholar 

  20. Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154(16):1838–40.

    Article  CAS  PubMed  Google Scholar 

  21. Cohen MS, Arslan N, Dehdashti F, Doherty GM, Lairmore TC, Brunt LM, et al. Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography. Surgery. 2001;130(6):941–6.

    Article  CAS  PubMed  Google Scholar 

  22. Steele SR, Martin MJ, Mullenix PS, Azarow KS, Andersen CA. The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography. Arch Surg. 2005;140(10):981–5.

    Article  PubMed  Google Scholar 

  23. Carroll BA. Asymptomatic thyroid nodules: incidental sonographic detection. AJR Am J Roentgenol. 1982;138(3):499–501.

    Article  CAS  PubMed  Google Scholar 

  24. Woestyn J, Afschrift M, Schelstraete K, Vermeulen A. Demonstration of nodules in the normal thyroid by echography. Br J Radiol. 1985;58(696):1179–82.

    Article  CAS  PubMed  Google Scholar 

  25. Brander AE, Viikinkoski VP, Nickels JI, Kivisaari LM. Importance of thyroid abnormalities detected at US screening: a 5-year follow-up. Radiology. 2000;215(3):801–6.

    Article  CAS  PubMed  Google Scholar 

  26. Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol. 2004;60(1):21–8.

    Article  Google Scholar 

  27. Smith-Bindman R, Lebda P, Feldstein VA, Sellami D, Goldstein RB, Brasic N, et al. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med. 2013;173(19):1788–96.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ahmed S, Horton KM, Jeffrey RB Jr, Sheth S, Fishman EK. Incidental thyroid nodules on chest CT: review of the literature and management suggestions. AJR Am J Roentgenol. 2010;195(5):1066–71.

    Article  PubMed  Google Scholar 

  29. Yoon DY, Chang SK, Choi CS, Yun EJ, Seo YL, Nam ES, et al. The prevalence and significance of incidental thyroid nodules identified on computed tomography. J Comput Assist Tomogr. 2008;32(5):810–5.

    Article  PubMed  Google Scholar 

  30. Youserm DM, Huang T, Loevner LA, Langlotz CP. Clinical and economic impact of incidental thyroid lesions found with CT and MR. AJNR Am J Neuroradiol. 1997;18(8):1423–8.

    CAS  PubMed  Google Scholar 

  31. Frank L, Quint LE. Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules. Cancer Imaging. 2012;12:41–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Shetty SK, Maher MM, Hahn PF, Halpern EF, Aquino SL. Significance of incidental thyroid lesions detected on CT: correlation among CT, sonography, and pathology. AJR Am J Roentgenol. 2006;187(5):1349–56.

    Article  PubMed  Google Scholar 

  33. Miyakoshi A, Dalley RW, Anzai Y. Magnetic resonance imaging of thyroid cancer. Top Magn Reson Imaging. 2007;18(4):293–302.

    Article  PubMed  Google Scholar 

  34. Nguyen XV, Choudhury KR, Eastwood JD, Lyman GH, Esclamado RM, Werner JD, et al. Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules. AJNR Am J Neuroradiol. 2013;34(9):1812–7.

    Article  CAS  PubMed  Google Scholar 

  35. Are C, Hsu JF, Schoder H, Shah JP, Larson SM, Shaha AR. FDG-PET detected thyroid incidentalomas: need for further investigation? Ann Surg Oncol. 2007;14(1):239–47.

    Article  PubMed  Google Scholar 

  36. Salvatori M, Melis L, Castaldi P, Maussier ML, Rufini V, Perotti G, et al. Clinical significance of focal and diffuse thyroid diseases identified by (18)F-fluorodeoxyglucose positron emission tomography. Biomed Pharmacother. 2007;61(8):488–93.

    Article  CAS  PubMed  Google Scholar 

  37. Bogsrud TV, Karantanis D, Nathan MA, Mullan BP, Wiseman GA, Collins DA, et al. The value of quantifying 18F-FDG uptake in thyroid nodules found incidentally on whole-body PET-CT. Nucl Med Commun. 2007;28(5):373–81.

    Article  PubMed  Google Scholar 

  38. Choi JY, Lee KS, Kim HJ, Shim YM, Kwon OJ, Park K, et al. Focal thyroid lesions incidentally identified by integrated 18F-FDG PET/CT: clinical significance and improved characterization. J Nucl Med. 2006;47(4):609–15.

    PubMed  Google Scholar 

  39. Chu QD, Connor MS, Lilien DL, Johnson LW, Turnage RH, Li BD. Positron emission tomography (PET) positive thyroid incidentaloma: the risk of malignancy observed in a tertiary referral center. Am Surg. 2006;72(3):272–5.

    PubMed  Google Scholar 

  40. Soelberg KK, Bonnema SJ, Brix TH, Hegedus L. Risk of malignancy in thyroid incidentalomas detected by 18F-fluorodeoxyglucose positron emission tomography: a systematic review. Thyroid. 2012;22(9):918–25.

    Article  CAS  PubMed  Google Scholar 

  41. Nishimori H, Tabah R, Hickeson M, How J. Incidental thyroid “PETomas”: clinical significance and novel description of the self-resolving variant of focal FDG-PET thyroid uptake. Can J Surg J Can Chir. 2011;54(2):83–8.

    Article  Google Scholar 

  42. Are C, Hsu JF, Ghossein RA, Schoder H, Shah JP, Shaha AR. Histological aggressiveness of fluorodeoxyglucose positron-emission tomogram (FDG-PET)-detected incidental thyroid carcinomas. Ann Surg Oncol. 2007;14(11):3210–5.

    Article  PubMed  Google Scholar 

  43. Chen YK, Ding HJ, Chen KT, Chen YL, Liao AC, Shen YY, et al. Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for cancer screening in healthy subjects. Anticancer Res. 2005;25(2B):1421–6.

    PubMed  Google Scholar 

  44. Chun AR, Jo HM, Lee SH, Chun HW, Park JM, Kim KJ, et al. Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography. Endocrinol Metab (Seoul). 2015;30(1):71–7.

    Article  Google Scholar 

  45. Chen W, Parsons M, Torigian DA, Zhuang H, Alavi A. Evaluation of thyroid FDG uptake incidentally identified on FDG-PET/CT imaging. Nucl Med Commun. 2009;30(3):240–4.

    Article  CAS  PubMed  Google Scholar 

  46. Bahl M, Sosa JA, Nelson RC, Hoang JK. Imaging-detected incidental thyroid nodules that undergo surgery: a single-center experience over 1 year. AJNR Am J Neuroradiol. 2014;35(11):2176–80.

    Article  CAS  PubMed  Google Scholar 

  47. Hobbs HA, Bahl M, Nelson RC, Kranz PG, Esclamado RM, Wnuk NM, et al. Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system? AJR Am J Roentgenol. 2014;202(1):18–24.

    Article  PubMed  Google Scholar 

  48. Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin N Am. 2007;36(3):707–35. vi

    Article  CAS  Google Scholar 

  49. Curtis RE, Rowlings PA, Deeg HJ, Shriner DA, Socie G, Travis LB, et al. Solid cancers after bone marrow transplantation. N Engl J Med. 1997;336(13):897–904.

    Article  CAS  PubMed  Google Scholar 

  50. Pacini F, Vorontsova T, Demidchik EP, Molinaro E, Agate L, Romei C, et al. Post-Chernobyl thyroid carcinoma in Belarus children and adolescents: comparison with naturally occurring thyroid carcinoma in Italy and France. J Clin Endocrinol Metab. 1997;82(11):3563–9.

    CAS  PubMed  Google Scholar 

  51. Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Miyauchi A, Kudo T, Kihara M, Higashiyama T, Ito Y, Kobayashi K, et al. Relationship of biochemically persistent disease and thyroglobulin-doubling time to age at surgery in patients with papillary thyroid carcinoma. Endocr J. 2013;60(4):415–21.

    CAS  PubMed  Google Scholar 

  53. Barroeta JE, Wang H, Shiina N, Gupta PK, Livolsi VA, Baloch ZW. Is fine-needle aspiration (FNA) of multiple thyroid nodules justified? Endocr Pathol. 2006;17(1):61–5.

    Article  PubMed  Google Scholar 

  54. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab. 2006;91(9):3411–7.

    Article  CAS  PubMed  Google Scholar 

  55. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007;142(6):837–44; discussion 44 e1-3.

    Google Scholar 

  56. Hanna BC, Brooker DS. A preliminary study of simple voice assessment in a routine clinical setting to predict vocal cord paralysis after thyroid or parathyroid surgery. Clin Otolaryngol. 2008;33(1):63–6.

    Article  CAS  PubMed  Google Scholar 

  57. Jarlov AE, Nygaard B, Hegedus L, Hartling SG, Hansen JM. Observer variation in the clinical and laboratory evaluation of patients with thyroid dysfunction and goiter. Thyroid. 1998;8(5):393–8.

    Article  CAS  PubMed  Google Scholar 

  58. Elisei R, Bottici V, Luchetti F, Di Coscio G, Romei C, Grasso L, et al. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab. 2004;89(1):163–8.

    Article  CAS  PubMed  Google Scholar 

  59. Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med. 2005;142(11):926–31.

    Article  PubMed  Google Scholar 

  60. Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab. 2006;91(11):4295–301.

    Article  CAS  PubMed  Google Scholar 

  61. Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab. 2008;93(3):809–14.

    Article  CAS  PubMed  Google Scholar 

  62. Cases JA, Surks MI. The changing role of scintigraphy in the evaluation of thyroid nodules. Semin Nucl Med. 2000;30(2):81–7.

    Article  CAS  PubMed  Google Scholar 

  63. Kroeker TR, le Nobel G, Merdad M, Freeman JL. Outcomes of incidentally discovered thyroid nodules referred to a high-volume head and neck surgeon. Head Neck. 2014;36(1):126–9.

    Article  PubMed  Google Scholar 

  64. Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99(4):1253–63.

    Article  CAS  PubMed  Google Scholar 

  65. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260(3):892–9.

    Article  PubMed  Google Scholar 

  66. Anil G, Hegde A, Chong FH. Thyroid nodules: risk stratification for malignancy with ultrasound and guided biopsy. Cancer Imaging. 2011;11:209–23.

    PubMed  PubMed Central  Google Scholar 

  67. Bahl M, Sosa JA, Nelson RC, Hobbs HA, Wnuk NM, Hoang JK. Thyroid cancers incidentally detected at imaging in a 10-year period: how many cancers would be missed with use of the recommendations from the Society of Radiologists in Ultrasound? Radiology. 2014;271(3):888–94.

    Article  PubMed  Google Scholar 

  68. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998;8(1):15–21.

    Article  CAS  PubMed  Google Scholar 

  69. Carmeci C, Jeffrey RB, McDougall IR, Nowels KW, Weigel RJ. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid. 1998;8(4):283–9.

    Article  CAS  PubMed  Google Scholar 

  70. Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002;87(11):4924–7.

    Article  CAS  PubMed  Google Scholar 

  71. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer. 1985;56(3):531–8.

    Article  CAS  PubMed  Google Scholar 

  72. Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34(1):28–35.

    Article  PubMed  Google Scholar 

  73. Mitchell JC, Grant F, Evenson AR, Parker JA, Hasselgren PO, Parangi S. Preoperative evaluation of thyroid nodules with 18FDG-PET/CT. Surgery. 2005;138(6):1166–74; discussion 74-5.

    Google Scholar 

  74. de Geus-Oei LF, Pieters GF, Bonenkamp JJ, Mudde AH, Bleeker-Rovers CP, Corstens FH, et al. 18F-FDG PET reduces unnecessary hemithyroidectomies for thyroid nodules with inconclusive cytologic results. J Nucl Med. 2006;47(5):770–5.

    PubMed  Google Scholar 

  75. Deandreis D, Al Ghuzlan A, Auperin A, Vielh P, Caillou B, Chami L, et al. Is (18)F-fluorodeoxyglucose-PET/CT useful for the presurgical characterization of thyroid nodules with indeterminate fine needle aspiration cytology? Thyroid. 2012;22(2):165–72.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of Interest

All authors state that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA

    Danae A. Delivanis MD & M. Regina Castro MD

Authors
  1. Danae A. Delivanis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Regina Castro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Regina Castro MD .

Editor information

Editors and Affiliations

  1. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

    Hossein Gharib

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Delivanis, D.A., Regina Castro, M. (2018). Thyroid Incidentalomas. In: Gharib, H. (eds) Thyroid Nodules. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-59474-3_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-59474-3_11

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-59473-6

  • Online ISBN: 978-3-319-59474-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation